ÉLAN VITAL HEALTHCARE, INC.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THAT INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY!
This Practice is committed to maintaining the privacy of your protected health
information ("PHI"), which includes information about your health condition and
the care and treatment you receive from the Practice.
The creation of a record detailing the care and services you receive
helps this office to provide you with quality health care.
This Notice details how your PHI may be used and disclosed to third
parties. This Notice also details
your rights regarding your PHI. The privacy of PHI in patient files will be
protected when the files are taken to and from the Practice by placing the files
in a box or brief case and kept within the custody of a doctor or employee of
the Practice authorized to remove the files from the Practice’s office. It may
be necessary to take patient files to a facility where a patient is confined or
to a patient’s home where the patient is to be examined or treated.
NO CONSENT REQUIRED
The Practice may use and/or disclose your PHI for the purposes of:
•
(a) Treatment - In order to provide you with the health care you require,
the Practice will provide your PHI to those health care professionals, whether
on the Practice's staff or not, directly involved in your care so that they may
understand your health condition and needs.
For example, a physician treating you for a condition or disease may need
to know the results of your latest physician examination by this office.
•
(b) Payment - In order to get paid for services provided to you, the
Practice will provide your PHI, directly or through a billing service, to
appropriate third party payers, pursuant to their billing and payment
requirements. For example, the
Practice may need to provide the Medicare program with information about health
care services that you received from the Practice so that the Practice can be
properly reimbursed. The Practice
may also need to tell your insurance plan about treatment you are going to
receive so that it can determine whether or not it will cover the treatment
expense.
•
(c) Health Care Operations - In order for the Practice to operate in
accordance with applicable law and insurance requirements and in order for the
Practice to continue to provide quality and efficient care, it may be necessary
for the Practice to compile, use and/or disclose your PHI.
For example, the Practice may use your PHI in order to evaluate the
performance of the Practice's personnel in providing care to you.
1. The Practice may use and/or disclose your PHI, without a written Consent from
you, in the following additional instances:
(a) De-identified Information - Information that does not identify you
and, even without your name, cannot be used to identify you.
(b) Business Associate - To a business associate if the Practice obtains
satisfactory written assurance, in accordance with applicable law, that the
business associate will appropriately safeguard your PHI.
A business associate is an entity that assists the Practice in
undertaking some essential function, such as a billing company that assists the
office in submitting claims for payment to insurance companies or other payers.
(c) Personal Representative - To a person who, under applicable law, has
the authority to represent you in making decisions related to your health care.
(d) Emergency Situations -
•
(i) for the purpose of obtaining or rendering emergency treatment to you
provided that the Practice attempts to obtain your Consent as soon as possible;
or
•
(ii) to a public or private entity authorized by law or by its charter to
assist in disaster relief efforts, for the purpose of coordinating your care
with such entities in an emergency situation.
(e) Communication Barriers - If, due to substantial communication
barriers or inability to communicate, the Practice has been unable to obtain
your Consent and the Practice determines, in the exercise of its professional
judgment, that your Consent to receive treatment is clearly inferred from the
circumstances.
(f)
Public Health Activities - Such activities include, for example, information
collected by a public health authority, as authorized by law, to prevent or
control disease and that does not identify you and, even without your name,
cannot be used to identify you.
(g) Abuse, Neglect or Domestic Violence - To a government authority if
the Practice is required by law to make such disclosure.
If the Practice is authorized by law to make such a disclosure, it will
do so if it believes that the disclosure is necessary to prevent serious harm.
(h) Health Oversight Activities - Such activities, which must be required by
law, involve government agencies and may include, for example, criminal
investigations, disciplinary actions, or general oversight activities relating
to the community's health care system.
(i) Judicial and Administrative Proceeding - For example, the Practice
may be required to disclose your PHI in response to a court order or a lawfully
issued subpoena.
(j) Law Enforcement Purposes - In certain instances, your PHI may have to
be disclosed to a law enforcement official.
For example, your PHI may be the subject of a grand jury subpoena.
Or, the Practice may disclose your PHI if the Practice believes that your
death was the result of criminal conduct.
(k) Coroner or Medical Examiner - The Practice may disclose your PHI to a
coroner or medical examiner for the purpose of identifying you or determining
your cause of death.
(l) Organ, Eye or Tissue Donation - If you are an organ donor, the
Practice may disclose your PHI to the entity to whom you have agreed to donate
your organs.
(m) Research - If the Practice is involved in research activities, your
PHI may be used, but such use is subject to numerous governmental requirements
intended to protect the privacy of your PHI and that does not identify you and,
even without your name, cannot be used to identify you.
(n) Avert a Threat to Health or Safety - The Practice may disclose your
PHI if it believes that such disclosure is necessary to prevent or lessen a
serious and imminent threat to the health or safety of a person or the public
and the disclosure is to an individual who is reasonably able to prevent or
lessen the threat.
(o) Workers' Compensation - If you are involved in a Workers'
Compensation claim, the Practice may be required to disclose your PHI to an
individual or entity that is part of the Workers' Compensation system.
(p) Disclosure of immunizations to schools required for admission upon
your informal agreement.
APPOINTMENT REMINDER
The Practice may, from time to time, contact you to provide appointment
reminders or information about treatment alternatives or other health-related
benefits and services that may be of interest to you.
The following appointment reminders are used by the Practice: a) a
postcard mailed to you at the address provided by you; and b) telephoning your
home and leaving a message on your answering machine or with the individual
answering the phone.
DIRECTORY/SIGN-IN LOG
The Practice maintains a directory of and sign-in log for individuals
seeking care and treatment in the office. Directory and sign-in log are located
in a position where staff can readily see who is seeking care in the office, as
well as the individual's location within the Practice's office suite.
This information may be seen by, and is accessible to, others who are
seeking care or services in the Practice's offices.
FAMILY/FRIENDS
The Practice may disclose to your family member, other relative, a close
personal friend, or any other person identified by you, your PHI directly
relevant to such person's involvement with your care or the payment for your
care unless you direct the Practice to the contrary.
The Practice may also use or disclose your PHI to notify or assist in the
notification (including identifying or locating) a family member, a personal
representative, or another person responsible for your care, of your location,
general condition or death.
However, in both cases, the following conditions will apply:
•
(a) If you are present at or prior to the use or disclosure of your PHI,
the Practice may use or disclose your PHI if you agree, or if the Practice can
reasonably infer from the circumstances, based on the exercise of its
professional judgment that you do not object to the use or disclosure.
•
(b) If you are not present, the Practice will, in the exercise of
professional judgment, determine whether the use or disclosure is in your best
interests and, if so, disclose only the PHI that is directly relevant to the
person's involvement with your care.
AUTHORIZATION
Uses and/or disclosures, other than those described above, will be made
only with your written Authorization.
YOUR RIGHTS
1. You have the right to:
(a) Revoke any Authorization and/or Consent, in writing, at any time.
To request a revocation, you must submit a written request to the
Practice's Privacy Officer.
(b) Request restrictions on certain use and/or disclosure of your PHI as
provided by law. However, the Practice is not obligated to agree to any
requested restrictions. To request
restrictions, you must submit a written request to the Practice's Privacy
Officer. In your written request,
you must inform the Practice of what information you want to limit, whether you
want to limit the Practice's use or disclosure, or both, and to whom you want
the limits to apply. If the
Practice agrees to your request, the Practice will comply with your request
unless the information is needed in order to provide you with emergency
treatment.
(c) Receive confidential communications or PHI by alternative means or at
alternative locations. You must
make your request in writing to the Practice's Privacy Officer.
The Practice will accommodate all reasonable requests.
(d) Inspect and obtain a copy your PHI as provided by 45 CFR 164.524.
To inspect and copy your PHI, you are requested to submit a written
request to the Practice's Privacy Officer.
The Practice can charge you a fee for the cost of copying, mailing or
other supplies associated with your request
(e) Amend your PHI as provided by 45 CFR 164.528.
To request an amendment, you must submit a written request to the
Practice's Privacy Officer. You
must provide a reason that supports your request.
The Practice may deny your request if it is not in writing, if you do not
provide a reason in support of your request, if the information to be amended
was not created by the Practice (unless the individual or entity that created
the information is no longer available), if the information is not part of your
PHI maintained by the Practice, if the information is not part of the
information you would be permitted to inspect and copy, and/or if the
information is accurate and complete.
If you disagree with the Practice's denial, you will have the right to
submit a written statement of disagreement.
(f) Receive an accounting of disclosures of your PHI as provided by 45
CFR 164.528. The request should indicate in what form you want the list (such as
a paper or electronic copy)
(g) Receive a paper copy of this Privacy Notice from the Practice upon
request to the Practice's Privacy Officer.
(h) Receive notice of any breach of confidentiality of your PHI by the
Practice.
(i) Prohibit report of any test, examination or treatment to your health
plan or anyone else for which you pay in cash or by credit card.
(j) Complain to the Practice or to the Office of Civil Rights, U.S.
Department of Health and Human Services, 200 Independence Avenue, S.W., Room
509F, HHH Building, Washington, D.C. 20201, 202 619-0257, email: ocrmail@hhs.gov
or to the Florida Attorney General, Office of the Attorney General, PL-01 The
Capitol, Tallahassee, FL 32399-1050, 850 414-3300 if you believe your privacy
rights have been violated. To file
a complaint with the Practice, you must contact the Practice's Privacy Officer.
All complaints must be in writing.
(k) Request copies of your PHI in electronic format.
To obtain more information on, or have your questions about your rights
answered, you may contact the Practice's Privacy Officer, Peter V. Matrale,
D.C., at 954-267-9963 or via email at ElanVitalHealth@aol.com.
PRACTICE'S REQUIREMENTS
1. The Practice:
•
(a) Is required by federal law to maintain the privacy of your PHI and to
provide you with this Privacy Notice detailing the Practice's legal duties and
privacy practices with respect to your PHI.
•
(b) Is required by State law to maintain a higher level of
confidentiality with respect to certain portions of your medical information
that is provided for under federal law.
In particular, the Practice is required to comply with the following
State statutes:
Section 381.004 relating to HIV testing, Chapter 384 relating to sexually
transmitted diseases and Section 456.057 relating to patient records ownership,
control and disclosure.
•
(c) Is required to abide by the terms of this Privacy Notice.
•
(d) Reserves the right to change the terms of this Privacy Notice and to
make the new Privacy Notice provisions effective for your entire PHI that it
maintains.
•
(e) Will distribute any revised Privacy Notice to you prior to
implementation.
•
(f) Will not retaliate against you for filing a complaint.
QUESTIONS AND COMPLAINTS
You may obtain additional information about our privacy practices or
express concerns or complaints to the person identified below whom is the
Privacy Officer and Contact person appointed for this practice. The Privacy
Officer is Peter V. Matrale, D.C.
You may file a complaint with the Privacy Officer if you believe that
your privacy rights have been violated relating to release of your protected
health information. You may, also, submit a complaint to the Department of
Health and Human Services the address of which will be provided to you by the
Privacy Officer. We will not retaliate against you in any way if you file a
complaint.
EFFECTIVE DATE